Immunocompromised patients and coronavirus disease 2019: a review and recommendations for dental health care

In less than four months, an unprecedented pandemic changed the world scenario, closing institutions and commerce, paralyzing sports championships, blocking frontiers, and putting almost all populations in a house quarantine regimen. Immunocompromised patients are within the high-risk group to severe outcomes from COVID-19. However, there is no clear evidence of the association between impaired immune host status and complications from SARS-CoV-2 infection so far. The virus is transmitted by inhalation or direct contact with infected secretions, and therefore the dental office is a highly susceptible environment for such transmission. Here, we review the literature and discuss immunological COVID-19 related issues. We also make suggestions for immunocompromised patients’ support in this new emerging context of clinical dental practice. Until comprehensive findings are published, individuals with impaired immunity should be considered as high-risk. Cross infection control procedures for the clinical care of immunocompromised patients should follow the same guidelines that are being proposed for immunocompetent ones. However, during the active outbreak, people under immunosuppressive conditions should not receive elective procedures, even if they do not have symptoms or exposure history to COVID-19, and in case of emergence, care must be done in a separate airborne room. In the pos-pandemic phase, the dental care general recommendations should be the same for all subjects. Changes in the current guidelines have been proposed to SARS-CoV-2 infection control in order to provide the best and safe dental practice. However, they still need to be validated by future studies

Quality of life in patients with chronic kidney disease

AIM: To compare the dimensions of quality of life in the stages of chronic kidney disease and the influence of sociodemographic, clinical and laboratory data. INTRODUCTION: The information available on the quality of life of patients on conservative treatment and the relationship between the quality of life and glomerular filtration rate is limited. METHODS: 155 patients in stages 1-5 of chronic kidney disease and 36 in hemodialysis were studied. Quality of life was rated by the Medical Outcomes Study Short Form 36-Item (SF-36) and functional status by the Karnofsky Performance Scale. Clinical, laboratory and sociodemographic variables were investigated. RESULTS: Quality of life decreased in all stages of kidney disease. A reduction in physical functioning, physical role functioning and in the physical component summary was observed progressively in the different stages of kidney disease. Individuals with higher educational level who were professionally active displayed higher physical component summary values, whereas men and those with a higher income presented better mental component summary values. Older patients performed worse on the physical component summary and better on the mental component summary. Hemoglobin levels correlated with higher physical component summary values and the Karnofsky scale. Three or more comorbidities had an impact on the physical dimension. CONCLUSION: Quality of life is decreased in renal patients in the early stages of disease. No association was detected between the stages of the disease and the quality of life. It was possible to establish sociodemographic, clinical and laboratory risk factors for a worse quality of life in this population

Dimensionamento de pessoal de enfermagem: análise do tempo efetivo de trabalho das enfermeiras da UTI pediátrica do HU-USP

The purposes of this study were to evaluate effective time of the nurse’s work during the morning shift at the Pediatric ICU of HU-USP, to identify percentage of effective time of work of these nurses dedicated to direct and indirect assistance and to determine the index of productivity of the professionals doing a retrospective analysis of daily activities records. The mean of the effective time a month of these nurses’ work corresponded to 275.5 minutes, of which 49.9% were related to indirect and 50.1% to direct assistance. According to the evaluation criterion available in the literature, the productivity index found is between satisfactory and excellent.Este estudio tuvo por objetivos estimar el tiempo efectivo de trabajo de las enfermeras del turno de la mañana de la UTI Pediátrica del HU-USP; identificar el percentual de tiempo efectivo de trabajo de esas enfermeras dedicado a la asistencia directa e indirecta y determinar el índice de productividad de estas profesionales, a partir de un análisis retrospectivo de los registros de las actividades diarias realizadas. La media mensual de tiempo efectivo de trabajo de esas enfermeras correspondió a 275.5 minutos, de los cuales 49.9% se referieron a la asistencia indirecta y 50.1% a asistencia directa. El índice de productividad encontrado se situa entre satisfactorio y excelente, conforme el criterio de evaluación disponible en la literatura.Este estudo teve por objetivos: estimar o tempo efetivo de trabalho das enfermeiras do turno da manhã da UTI Pediátrica do HU-USP; identificar o percentual do tempo efetivo de trabalho dessas enfermeiras dedicado à assistência direta e indireta; e determinar o índice de produtividade dessas profissionais a partir da análise retrospectiva dos registros das atividades diárias realizadas. A média mensal do tempo efetivo de trabalho dessas enfermeiras correspondeu à 275,5 minutos, dos quais 49,9% referem-se à assistência indireta e 50,1% à assistência direta. O índice de produtividade encontrado situa-se entre satisfatório e excelente, de acordo com o critério de avaliação disponível na literatura

Narratividade e o direito à diferença: a alteridade como proposta de superação da exclusão = Narrativity and the right of difference: the otherness as a proposal of overcome exclusion = Narratividad y derecho a la diferencia: la alteridad como propuesta para superar la exclusión

- DOI: https://doi.org/10.30612/videre.v13i27.1425

Peptidylprolyl isomerase C (Ppic) regulates invariant Natural Killer T cell (iNKT) differentiation in mice

© 2021 The Authors. European Journal of Immunology published by Wiley-VCH GmbH. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Peptidyl-prolyl cis-trans isomerase C (Ppic) is expressed in several bone marrow (BM) hematopoietic progenitors and in T-cell precursors. Since the expression profile of Ppic in the hematoimmune system was suggestive that it could play a role in hematopoiesis and/or T lymphocyte differentiation, we sought to test that hypothesis in vivo. Specifically, we generated a Ppic-deficient mouse model by targeting the endogenous locus by CRISPR/Cas9 and tested the requirement of Ppic in hematopoiesis. Several immune cell lineages covering BM progenitors, lymphocyte precursors, as well as mature cells at the periphery were analyzed. While most lineages were unaffected, invariant NKT (iNKT) cells were reduced in percentage and absolute cell numbers in the Ppic-deficient thymus. This affected the most mature stages in the thymus, S2 and S3, and the phenotype was maintained at the periphery. Additionally, immature transitional T1 and T2 B lymphocytes were increased in the Ppic-deficient spleen, but the phenotype was lost in mature B lymphocytes. In sum, our data show that Ppic is dispensable for myeloid cells, platelets, erythrocytes, αβ, and γδ T lymphocytes in vivo in the steady state, while being involved in B- and iNKT cell differentiation.This work was supported by the Instituto Gulbenkian de Ciência (IGC) of the Calouste Gulbenkian Foundation, and the Portuguese National Research Council (Fundação para a Ciência e Tecnologia [FCT]) Grant PTDC/BIA-BID/30925/2017 to VCM, that also supports the salary of RSP. VCM is supported by an individual contract awarded by FCT (CEECIND/03106/2018). CVR is a PhD student of the IGC Integrative Biology and Biomedicine (IBB) PhD Program and supported by an individual FCT PhD Fellowship ref. PD/BD/139190/2018. This work had the support of the research infrastructures Congento LISBOA-01-0145-FEDER-022170 and PPBI-POCI-01-0145-FEDER-022122, both cofinanced by FCT and Lisboa2020, under PORTUGAL2020 agreement (European Regional Development Fund).info:eu-repo/semantics/publishedVersio

Estudo comparativo, prospectivo e randomizado entre uroterapia e tratamento farmacológico em crianças com incontinência urinária

OBJECTIVE: To verify and compare the results of behavioral modification plus pelvic floor muscle training and behavioral modifications plus oxybutynin chloride in children with nonmonosymptomatic enuresis. METHODS: A total of 47 children were randomized using opaque and sealed envelopes sequentially numbered. Group I was composed of 21 children who underwent antimuscarinic treatment (oxybutynin), and Group II was composed of 26 patients who underwent pelvic floor muscle training. Both groups were instructed as to behavioral modifications. RESULTS: The voiding diary results were compared each month between Groups I and II. In the first month of treatment, children in Group I presented 12.2 dry nights, 13.4 in the second month, and 15.9 in the last month. In Group II, the results were: 14.9 dry nights in the first month, 20.8 dry nights in the second and 24.0 dry nights in the last month. There was a significant difference between the groups in second and third months. CONCLUSION: Pelvic floor exercises associated with behavioral changes were more effective than pharmacological treatment in children with urinary incontinence.OBJETIVO: Verificar e comparar os resultados da modificação comportamental associado ao treinamento dos músculos do assoalho pélvico e modificação comportamental associado ao uso de cloridrato de oxibutinina em crianças com enurese não monossintomática. MÉTODOS: Foram randomizadas 47 crianças por meio de envelopes opacos e selados com numeração sequencial. O Grupo I foi composto por 21 crianças que receberam tratamento com antimuscarínico (oxibutinina) e o Grupo II por 26 pacientes que receberam treinamento dos músculos do assoalho pélvico. Ambos os grupos foram instruídos em relação à modificação comportamental. RESULTADOS: Os resultados do diário miccional foram comparados cada mês entre os Grupos I e II. No primeiro mês de tratamento, as crianças do Grupo I apresentaram 12,2 noites secas, 13,4 no segundo mês e 15,9 no último mês. No Grupo II, os resultados foram: 14,9 noites secas no primeiro mês, 20,8 no segundo mês e 24,0 no último mês. Houve diferença significativa entre os grupos no segundo e no terceiro mês. CONCLUSÃO: Os exercícios do assoalho pélvico associados a mudança comportamental foram mais efetivos do que o tratamento farmacológico em crianças com incontinência urinária.20320

Nursing care time in the Intensive Care Unit: evaluation of the parameters proposed in COFEN Resolution Nº 293/04

O estudo teve por objetivo avaliar os parâmetros preconizados pela Resolução COFEN nº293/04, enquanto referência para o dimensionamento de pessoal de Enfermagem em e Terapia Intensiva Adulto (UTIA). A pesquisa foi desenvolvida em seis hospitais da cidade de São Paulo. Os quantitativos médios diários de profissionais, necessários para o atendimento dos pacientes, foram calculados conforme parâmetros preconizados pelo COFEN. Os resultados obtidos foram comparados ao quantitativo diário de pessoal existente nessas unidades. Observou-se que as proporções recomendadas pelo COFEN, para a categoria enfermeiro, são superiores às utilizadas pelos hospitais estudados, configurando-se em um desafio para a Enfermagem brasileira. Constatou-se que os valores referentes aos tempos médios de assistência são adequados e constituem importante referencial para o dimensionamento do quantitativo mínimo de profissionais, nas UTIAs. Com este estudo, evidenciaram-se contribuições para a validação dos parâmetros indicados pela Resolução COFEN nº293/04, para o dimensionamento de pessoal de Enfermagem em UTIA.Este estudio tuvo como objetivo evaluar los parámetros establecidos por la Resolución COFEN 293/04, referencia para dimensionamiento de personal de enfermería en unidades de cuidados intensivos adultos (UCIA). La investigación se realizó en seis hospitales de la ciudad de São Paulo. La cantidad media diaria de profesionales necesarios para la asistencia al paciente se calculó de acuerdo a los parámetros establecidos por COFEN. Los resultados se compararon al cuantitativo diario de personal existente en estas Unidades. Se observó que las proporciones recomendadas por COFEN, categoría enfermera, son superiores a las utilizadas por los hospitales convirtiéndose desafío para la enfermería brasileña. Se encontró que los valores del tiempo medio de asistencia son adecuadas y representan importante referencia para el dimensionamiento del cuantitativo mínimo de profesionales en UCIA. Este estudio evidencia contribuciones para validación de los parámetros especificados en la Resolución COFEN 293/04, para el dimensionamiento del personal de enfermería en UCIA.This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in São Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU

a clinical and molecular study

Funding This work was funded by Fundação para a Ciência e Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior (FCT/MCTES, Portugal) through national funds to iNOVA4Health (UIDB/04462/2020 and UIDP/04462/2020) and the Associated Laboratory LS4FUTURE (LA/P/0087/ 2020), by Associação de Endocrinologia Oncológica (AEO), and by Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG). Carolina Pires was granted with a PhD scholarship by FCT - 2020.07120.BD. Ricardo Rodrigues was granted with a PhD scholarship by iNOVA4Health Research Unit - UIDP/04462/2020; UI/BD/ 154256/2022.OBJECTIVES: Anaplastic thyroid carcinoma (ATC) has a poor survival. The combination of Dabrafenib plus Trametinib (DT) had a significant impact in survival of BRAF p.V600E patients. However, durable responses may be compromised by resistance. We aim to present our experience with DT in BRAF positive ATC patients and compare the outcomes with usual therapy, and to study tumor molecular alterations in the DT group. METHODS: Patients treated between May 2018 and April 2022 in a tertiary referral center, assessed for BRAF status were included. Patients were divided in three groups: BRAF p.V600E treated with DT, BRAF wild type (WT) under multimodal therapy (MT), and BRAF WT under compassionate care (CC). Response was assessed monthly in the first 6 months and every 3 months afterwards, by RECIST 1.1. Overall survival (OS) and progression-free survival (PFS) were estimated with the Kaplan-Meier method and compared with the log-rank test. RESULTS: Twenty-seven ATC patients were included (DT = 9, MT = 8, and CC = 10). Median OS was 475 days for DT, 156 days for MT, and 39 days for CC (P < .001). At 12 months, only patients in the DT group were alive (71%). Median PFS was 270 days, in the DT group, compared with less than 32 days in BRAF WT (P < .001). No severe adverse events were reported. Molecular profiling showed that in one of the four clinical progressions, a pathogenic NRAS mutation was found. CONCLUSIONS: Our results show a significant real-world efficacy of Dabrafenib plus Trametinib in both survival and recurrence compared with standard treatment, with a good safety profile.publishersversionpublishe

Alteração do filme lacrimal e superfície ocular em usuários crônicos de medicação antiglaucomatosa

PURPOSE: Tear film can be altered by chronic medications that may disrupt the equilibrium responsible for the functioning of the lacrimal gland and ocular surface. The purpose of this study was to determine if antiglaucomatous chronic treatment induced alterations in the tear film and ocular surface. METHODS: After informed consent, 21 patients using antiglaucomatous eye drops for more than 8 months and 20 age- and sex-matched volunteers without eye and systemic medications (control group) were enrolled. The data of ocular discomfort, fluorescein and lisamine green staining, tear film break-up time and Schirmer test were collected and compared by Student's t test. The impression cytology data were graded and compared by chi-square test. RESULTS: Patients chronically using antiglaucomatous medications presented with significant higher fluorescein staining (p=0.003), lisamine green staining (p=0.02) and lower TFBUT (p=0.001). The other comparedparameters, including impression cytology were similar between the treated and control group (p>0.05). CONCLUSIONS: The present study shows that the tear film and the ocular surface are altered in patients under antiglaucomatous medications. In common, all medications were preserved with benzalkonium chloride. Efforts to minimize the adverse effects of chronic use of antiglaucomatous drugs must be addressed.OBJETIVO: O filme lacrimal pode ser alterado por medicações crônicas, que podem comprometer o equilíbrio responsável pela função da glândula lacrimal e da superfície ocular. O objetivo desse estudo foi determinar se o tratamento crônico com drogas antiglaucomatosas induz alterações no filme lacrimal e superfície ocular. MÉTODOS: Após o consentimento informado, 21 pacientes usando drogas antiglaucomatosas por mais de 8 meses e 20 voluntários com similar distribuição etária e por sexo, não usuários de medicação ocular ou sistêmica (grupo controle) foram incluídos. Os dados do desconforto ocular, coloração com fluoresceína e lissamina verde, tempo de ruptura do filme lacrimal e teste de Schirmer foram colhidos e analisados pelo teste t de Student. A citologia de impressão foi avaliada e comparada pelo teste de qui-quadrado. RESULTADOS: Pacientes usando cronicamente medicação antiglaucomatosa apresentaram ignificativamente maior coloração por fluoresceína (p=0,003), lissamina verde (p=0,02) e menor TRFL (p=0,001). Os outros parâmetros comparados, incluindo a citologia de impressão foram similares entre o grupo tratado e controle (p>0,05). CONCLUSÕES: Esse estudo demonstra que o filme lacrimal e a superfície ocular estão alterados em usuários de medicação antiglaucomatosa. Essas medicações apresentam em comum o cloreto de benzalcônio como conservante. Esforços para minimizar efeitos adversos do uso crônico de drogas antiglaucomatosas devem ser considerados.CNPqFAEPAFAPES